Project Summary Systematically collecting patient-reported outcomes measures (PROMs) and using them in both the care of individual patients and as aggregate data for quality improvement of care processes has been a healthcare dream for the past 15 years. However, few organizations make even partial use of such a complete outcomes system. Furthermore, the evidence of impact on those outcomes is of poor quality, and the results are mixed. By partnering with operational leaders in a large medical group that has prioritized building a health information technology (HIT)-based PROMs system as well as obtaining input from both clinicians and patients, we propose to enhance the information collected, improve survey response rates from patients, and facilitate the likelihood of using the information in both the care of individual patients and for quality improvement. The medical group has already begun this initiative, focused initially on patients undergoing knee or hip replacements or spine surgery. We propose to supplement the initiative and to provide a much more complete and thorough scientific evaluation of its use and impacts than would otherwise be possible. Specifically, we propose to: 1. Interview and survey patients to learn what outcomes are important to them (Patient Preferred Outcomes [PPOs]) and what contextual information (Patient Contextual Information [PCI]) would be helpful to their clinicians in planning care 2. Test the impact of adding this information to the PROMs survey and HIT outreach on item and survey response rates in collecting outcomes information 3. Test the impact on outcomes and experience (satisfaction and shared decision-making) from making individual outcome scores available via the electronic medical record and Internet access during care 4. Test the impact on outcomes and costs over time from providing surgeons with both their aggregate PROM/PPO scores and the associated care costs in comparison with their peers The results of this research will be used by the medical group as it spreads an advanced PROMs system to other conditions and specialties while also serving as a real-life model system that will be disseminated widely through its strong links to other care systems regionally and nationally.